Provider Demographics
NPI:1871856773
Name:SCOTT, MARIAH LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2550 E GUADALUPE RD
Mailing Address - Street 2:#115
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5114
Mailing Address - Country:US
Mailing Address - Phone:480-632-1544
Mailing Address - Fax:480-632-1533
Practice Address - Street 1:6301 S MCCLINTOCK DR
Practice Address - Street 2:#101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3392
Practice Address - Country:US
Practice Address - Phone:480-831-6800
Practice Address - Fax:480-897-2799
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2016-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL1595208000000X
AZ006706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ028358Medicaid